After approximately 20 years follow-up there was no difference in survival between women with early breast cancer treated with mastectomy or with breast conservation therapy (BCT), according to a study published in the journal Cancer.

Led by Matthew M. Poggi of the National Cancer Institute in Bethesda, MD, researchers concluded that these findings are consistent with previous studies that show similar long-term overall and disease-free survival for mastectomy and BCT for the treatment of early breast cancer. Long-term disease recurrence in the treated breast occurred in patients treated with BCT at higher rates than previously reported and occurred as late as 20 years after treatment. These results underscore the efficacy and safety of breast conserving lumpectomy and radiation in the treatment of early breast cancer.

While there are no long-term survival differences between the two treatment modalities, "long-term in-breast events continue to be observed throughout the entire follow-up period" of 20 years in patients treated with BCT, conclude the authors, "and therefore warrant diligent surveillance."

BCT, consisting of lumpectomy, axillary lymph node evaluation and radiotherapy, continues to gain acceptance in the medical field as an effective alternative to the mastectomy in the treatment of early stage breast cancer. Studies show that while preserving healthy breast tissue and breast anatomy, it also successfully treats breast cancer. Still, questions persist about the long-term effect of radiation therapy on surrounding normal tissue and BCTs long-term efficacy compared to the current gold standard treatment, mastectomy.

Although long-term data is scarce, recent published results of 20 year follow-up data indicate that there is no difference in survival between mastectomy and BCT treated patients. In another update of long-term data comparing BCT and mastectomy, the authors evaluated follow-up data from the National Cancer Institute trial for 237 women randomized to treatment with either mastectomy or BCT and followed for approximately 20 years.

The patients were followed for up to 22 years with a median follow-up of 18.4 years. Overall survival at 18.4 years was similar between the mastectomy (58%) and BCT groups (54%). Disease-free survival at 18.4 years was also similar between the mastectomy (67%) and BCT groups (63%).

Within the BCT group, 22% developed cancer in the treated breast throughout the follow-up period and up to 20 years after treatment. Successful salvage treatment was achieved in 59% of these patients. There was no statistical difference in the incidence of distant metastases, contralateral breast cancer, and nonbreast cancer between the two groups.

"The inclusion of radiation as part of breast conserving therapy did not incur any increased risk to [the BCT group] as compared to the mastectomy group," suggest the authors.

In summary, "with nearly 20 years of follow-up, there is no detectable difference in overall survival or disease-free survival between the mastectomy and BCT arms," conclude the authors.

SOURCE:
Cancer, August 15, 2003

Specialist Breast Surgeons Give Patients Better Chance of Survival

Breast Cancer patients operated on 10 years ago by specialists have done better than those treated by surgeons with fewer breast cancer patients, a British study reveals.

Reporting their results in the British Journal of Cancer, Cancer Research UK scientists found that patients operated on by surgeons with an annual breast cancer caseload of more than 50 patients have a 68 percent chance of survival after five years.

But the survival rate dropped to 60 percent among patients whose surgeons performed fewer than 10 breast cancer operations a year. So if a specialist surgeon operates on 100 women, 8 more women will survive at least 5 years than if all 100 of them had been operated on by a less experienced colleague.

The study was carried out by Cancer Research UK using data from the Northern and Yorkshire Cancer Registry Information Service (NYCRIS) and was based on more than 11,000 patients over a five-year period.

It also found that the patients of specialist surgeons were more likely to have chemotherapy.

Dr. Jasmina Mikeljevic, who led the study for Cancer Research UK at St James' Hospital in Leeds, says: "Patients whose surgeons performed more than 30 breast cancer operations a year were less likely to have surgery on its own and more likely to have additional treatment.

"This is because surgeons with higher caseloads usually work in multi-disciplinary teams where they would join a wide range of cancer specialists and so patients would have more comprehensive access to other treatments.

"Our figures for survival were based on patients treated between 1989 and 1994. We believe the situation has steadily improved in Yorkshire since then and future data should bear this out."

In 1996, the Department of Health recommended that patients should be managed by breast cancer teams, which would include specialist surgeons. Mikeljevic believes the results of the NYCRIS study reinforce the importance of this recommendation.

Dr. John Toy, Medical Director at Cancer Research UK, says: "The study indicates that a woman with breast cancer has a better outlook if she is looked after by a team of expert medical staff working together as members of a multi-disciplinary team. Such a team should obviously include a specialist surgeon, who is doing breast cancer operations frequently.

SOURCES:
British Journal of Cancer, July 29, 2003
Cancer Research UK (http://www.cancerresearchuk.org)